Speaking as of the middle 1980s, hematological diagnostics is still practiced largely by the time-honored approach of lookup in authoritative works such as BI 1, or else the hematologist or physician depends upon his own memory. Either way, the approach is mental. As will be seen hereinafter, the hematological parameters which are processed by the Apparatus are four in number, they will be referred to throughout this description as P H G L; these are abbreviations for Platelet Count, Hematocrit, Granulocyte Count, Lymphocyte/Monocyte Count. Alternative abbreviations for these are # PLT, HCT, #GRANS, #LYMPH. The mental approach operates on the same, or similar parameters, or on parameters some of which are in the quartet just stated or similar thereto, plus other kinds of input data, e.g. patient history, clinical signs, other test results, etc. depending on the instrument-type or data source. The mental approach will now be discussed, assuming it is based on P H G L data, but the discussion is most general.
The parameters P H G L are presented to the "mental processor" (or the Apparatus) as numerics. The mental approach is by a method known in scientific or mathematical fields as trial-and-error method. On the basis of the quartet of parametric data on hand, the physician assumes that certain trial hematologic/diagnostic conditions or conclusions--plural ones (rather than just one single one) are quite common--apply to the quartet, and hence to the patient in question. Next comes lookup to see if the assumption is correct. If incorrect, another trial assumption is made, and the lookup is repeated. When eventually an assumption proves to be true or a "hit", the mental processor must continue to make trial assumptions, in order to be sure to reach all of the possibly plural "hits". For a physician who is quite experienced at this, the convergence of the process to the first correct conclusion, may be fairly rapid, because he or she will not likely assume--as an inexperienced physician might assume--a trial condition for which the given quartet of parametric numerics is far afield. Nevertheless, the trial-and-error process is too time-consuming, and is conducive to physician's diagnostic error of commission (because of fatigue, for example) and of omission (plural conclusions to be drawn).
To alleviate this situation, efforts have been made to partially automate or provide automated assistance in hematology-diagnostic processing. Before considering this, there now follows a brief review of automated systems, and in particular expert systems, directed to medical diagnostics, that is to the many fields of medicine including hematology, general medicine, and internal medicine.
The number of separate, individual, previously proposed systems directed to automated medical diagnostics is quite sizeable, but for most of these very few units were constructed. As to hematology diagnostic systems previously proposed, these are very few in number; only two have received significant publicity in the literature, and here too, for each of these two, very few units were constructed. The reasons for such limited construction, for hematology diagnostics will be presently discussed, and they apply also to general medical diagnostics.
The literature devoted to general medical diagnostic expert systems is quite extensive; BI 2 describes some and lists others in its own bibliography; indeed surveys or listings of these systems have been prepared, some with brief summaries devoted to each listed system; see BI 6 to BI 8 and BI 12.
As to hematology-diagnostic systems, their number is quite limited. One better-known system called HEME (see BI 9 to BI 12) was a computer program which used a probability approach to assist in the diagnosis of general hematologic disease. HEME was presented as a series of papers by Cornell University/International Business Machines (IBM). The development and operation of HEME spanned a time period of about 15 to 20 years. HEME was intended to operate as a continuously self-improving system. It was utilized chiefly as a research tool, and as a training device for student-hematologists. As is indicated in BI 11, pages 764, 765, HEME received little use for various reasons stated thereat.
The other better-known hematology-diagnostic system is ANEMIA which is described in BI 13. ANEMIA is an Italian-originated computer program which is designed to assist in the diagnosis of the anemia. Like HEME, ANEMIA was operated at a research center, and did not progress beyond that stage.
HEME and ANEMIA were far too complex to be used by physicians who are not also computer experts. The two systems were interactive (see BI 2), meaning that in order to develop a diagnosis, the user had to engage in a dialogwith the system sequentially so and repeatedly, with the system providing questions and answers in several tiers of interrogation. Of course, interactive systems have certain advantages in certain applications, but they are not too well-suited for the small-office practitioner. As will be seen hereinafter, the System of this invention is noninteractive; the user of the System needs very few skills in operating the system which essentially takes care of itself in a "one-shot-operation".
The user of at least one of the previously proposed medical diagnostic expert systems had to be well-versed in the cryptic computer-code language, to intercommunicate both ways with the apparatus. In contrast, in the System of this invention, output information is in human language in narrative sentence form, or in the so-called short mode, in short-slogan-type word arrangements, also expressed in simple human language, and little or no human input information is required.